Pennsylvania Initiative Keeping an Eye on the Store

When Gary D. Alexander took over as secretary of the Pennsylvania Department of Public Welfare in January 2011, he inherited a department with a $27 billion budget and more than 16,000 employees. The department has oversight of programs such as Medicaid, Temporary Assistance for Needy Families, the Supplemental Nutrition Assistance Program and early childhood education.

“That’s a lot of people and money to keep track of,” said Clint Eisenhower, director of the new Program Integrity Office for the Pennsylvania Department of Public Welfare. “We have program offices bigger than many state agencies.”

Alexander discovered the department was fraught with waste, fraud and abuse, and regularly requested supplemental budget appropriations, Eisenhower said. To address these issues, Pennsylvania tried an enterprise-wide solution never done before in the health and human services arena.

Thus began the Enterprise Program Integrity initiative, an East regional winner of The Council of State Governments’ 2012 Innovations Awards.

In July 2011, the Pennsylvania legislature passed Act 22, which in part said the department “shall establish uniform procedures to identify, investigate and resolve potential cases of fraud, misrepresentation or inadequate documentation prior to determining an applicant's eligibility for assistance.”

Eisenhower said Alexander tasked the staff with completing a comprehensive, four-month analysis to determine what was being done to verify a person’s eligibility for services, where each programs’ strengths and weaknesses lay and where they wanted the department to go in the future. The Department of Public Welfare, he said, already had people doing program integrity-related work—like the Bureau of Finance and Operations, which does auditing, and the Bureau of Program Integrity, which collects Medicaid provider overpayments. But the program offices often weren’t collaborating with each other and didn’t share resources.

The Program Integrity Office is charged with making sure programs work together, discover where more resources are needed and direct the public welfare department’s system-wide efforts to combat waste, fraud and abuse.

“At a meeting today, one of our program offices expressed concern they didn’t have access to data,” Eisenhower said. “I said ‘Another program office has access to that data. Why can’t you have access to it?’ The essence of program integrity is sharing information and best practices across programs.”

Eisenhower said one potential area of concern was when somebody suggested the state match up the names of people registered to provide services, such as childcare, with the list of people who are welfare recipients. That had never been done in Pennsylvania. The department ended up with 2,700 people who had not listed the income derived from the state on their applications for assistance.

Pennsylvania didn’t have a plan or process for collecting overpayments from its medical assistance program. It took a year to work out how to identify and refer the overpayments to the Office of Inspector General, from whom the state would try to collect overpayments, and how they would do it. Now the Office of Inspector General has 253 cases worth just over $500,000. The average amount each person owes is $2,227.

“We had seen statistics that as many as 20,000 medical assistance overpayments were not pursued for recovery,” he said. “It floored me that we weren’t trying to recover that.”

Eisenhower said an enterprise program integrity initiative can easily be transferred to any federal, state or even local agency. The key, he said, is to take a holistic look at the department or agency to see how all the pieces fit together and where there are gaps. It’s more important than ever, he said, to provide services efficiently to those in need.

“The goal at the end of the day is to provide very valuable services every day to people in need,” Eisenhower said. “We’re trying to protect tax dollars to provide them to truly needy Pennsylvanians.

“With dwindling resources, states have to be creative about how to use the resources they have. … Looking at program integrity is a good way to do that. You’d be surprised. We found hundreds of millions of dollars that didn’t have strong monitoring. Money was going out, but nobody was really watching how it was spent.

“Secretary Alexander’s vision and charge changed the department’s culture into a fiscally prudent organization focused on delivering value to taxpayers and recipients.”